Clubfoot also called talipes equinovarus, describes a range of foot abnormalities usually present at birth in which a baby's foot is twisted out of shape or position. It is a deformity of the foot and ankle that babies can be born with.
In clubfoot, the tissues (tendons) connecting the muscles to the bone are shorter than usual.
Clubfoot is a fairly common birth defect and is usually an isolated problem for an otherwise healthy newborn. Boys are twice more likely than girls to have the deformity.
Clubfoot can be mild or severe. About half of children with clubfoot have it in both feet. If your child has clubfoot, it will make it harder to walk normally, so doctors generally recommend treating it soon after birth and are usually able to treat it successfully without surgery, though in some occasion, children need follow-up surgery later on.
Signs and Symptoms
Each of the following visible signs may be present, and each may vary from mild to severe:
The foot (especially the heel) is usually smaller than normal.
The foot may point downward.
The front of the foot may be rotated toward the other foot.
The foot may turn in, and in extreme cases, the bottom of the foot can point up.
The calf muscles in the affected leg are usually underdeveloped.
Despite its look, however, clubfoot itself doesn't cause any discomfort or pain for babies, but it can become painful as they get older and cause difficulties walking if it isn’t treated.
What Causes Clubfoot?
In some cases, clubfoot is just the result of the position of the baby while it is developing in the mother's womb (postural clubfoot).
But more often clubfoot is caused by a combination of genetic and environmental factors that is not well understood. If someone in your family has clubfoot, then it is more likely to occur in your infant. If your family has one child with clubfoot, the chances of a second infant having the condition increase.
As soon as clubfoot is noticed, it's important that the infant be screened for other health conditions. Clubfoot can also be the result of problems that affect the nerve, muscle, and bone systems, such as stroke or brain injury.
Risk factors include:
Family history. If either of the parents or their other children have had clubfoot, the baby is more likely to have it as well.
Congenital conditions. In some cases, clubfoot can be associated with other abnormalities of the skeleton that are present at birth (congenital), such as spina bifida, a serious birth defect that occurs when the tissue surrounding the developing spinal cord of a foetus doesn't close properly.
Environment. If a woman with a family history of clubfoot smokes during pregnancy, her baby's risk of the condition may be double that of non-smokers. Also, getting an infection or using recreational drugs during pregnancy can increase the risk of clubfoot.
Not enough amniotic fluid during pregnancy. Too little of the fluid that surrounds the baby in the womb may increase the risk of clubfoot.
Clubfoot typically doesn't cause any problems until your child starts to stand and walk. If the clubfoot is treated, your child will most likely walk fairly normally. He or she may have some difficulty with:
Movement. Mobility may be slightly limited.
Shoe size. The affected foot may be smaller than the unaffected foot.
Calf size. The muscles of the calf on the affected side may always be smaller than the other side and this may make your child complain of "sore legs" or getting tired sooner than peers. The affected leg may also be slightly shorter than the unaffected leg, but this is rarely a significant problem.
However, if not treated, clubfoot causes more-serious problems. These can include:
Arthritis. Your child is likely to develop arthritis.
Poor self-image. The unusual appearance of the foot may make your child's body image a concern during the teen years.
Inability to walk normally. The twist of the ankle may not allow your child to walk on the sole of the foot. To compensate, he or she may walk on the ball of the foot, the outside of the foot or even the top of the foot in severe cases.
Problems stemming from walking adjustments. Walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the foot, and result in an awkward gait.
Ultrasound done while a baby is in the womb can sometimes detect clubfoot. While it's possible to clearly see some cases of clubfoot before birth during an ultrasound exam, nothing can be done before birth to solve the problem but knowing about the condition may give you time to learn more about clubfoot and get in touch with appropriate health experts, such as a genetic counsellor or an orthopaedic surgeon.
It is more common for your doctor to diagnose the condition after the infant is born, though, based on the appearance and mobility of the feet and legs. In some cases, especially if the clubfoot is due just to the position of the growing baby (postural clubfoot), the foot is flexible and can be moved into a normal or nearly normal position after the baby is born. In other cases, the foot is more rigid or stiff, and the muscles at the back of the calf are very tight.
X-rays may not be helpful to confirm the diagnosis. Some of the baby's foot and ankle bones are not fully ossified (filled in with bony material) and do not show well on X-ray.
Because your newborn's bones, joints and tendons are very flexible, treatment for clubfoot usually begins in the first week or two after birth. The goal of treatment is to improve the way your child's foot looks and works before he or she learns to walk, in hopes of preventing long-term disabilities.
Treatment options include:
Stretching and casting (Ponseti method)
Stretching and casting (Ponseti method)
This is the most common treatment for clubfoot. Your doctor will:
Move your baby's foot into a correct position and then place it in a cast to hold it there
Reposition and recast your baby's foot once or twice a week for several months
Perform a minor surgical procedure to lengthen the Achilles tendon (percutaneous Achilles tenotomy) toward the end of this process
After the shape of your baby's foot is realigned, you'll need to maintain it by doing one or more of the following:
1. Doing stretching exercises with your baby.
2. Putting your child in special shoes and braces.
3. Making sure your child wears the shoes and braces as long as needed — usually full time for three months, and then at night for up to three years.
For this method to be successful, you'll need to apply the braces according to your doctor's directions so that the foot doesn't return to its original position. The main reason this procedure sometimes doesn't work is because the braces are not used constantly.
If your baby's clubfoot is severe or doesn't respond to nonsurgical treatments, more invasive surgery may be needed. An orthopaedic surgeon can lengthen tendons to help ease the foot into a better position. After surgery, your child will be in a cast for up to two months, and then need to wear a brace for a year or so to prevent the clubfoot from coming back.
Even with treatment, clubfoot may not be totally correctable. But in most cases babies who are treated early grow up to wear ordinary shoes and lead normal, active lives.
Since, researchers are still uncertain about the cause of clubfoot, you can't completely prevent it. However, if you're pregnant, you can do things to limit your baby's risk of birth defects, such as:
Not smoking or spending time in smoky environments
Not drinking alcohol
Avoiding drugs not approved by your doctor
Helpful Tips in Using the Brace
Play with Your Child in the Brace
This is the key to getting over the irritability quickly. If your child is using the solid bar, he or she can kick and swing the legs simultaneously with the brace on. You can help facilitate this by gently bending and straightening the knees by pushing and pulling on the bar of the brace. If your child is using the dynamic bar, it is also helpful to gently move the legs up and down as your child adjusts to the brace.
Make It a Routine
Children do better if you develop a fixed routine for the bracewear. During the years of night and naptime wear, put the brace on anytime your child goes to the "sleeping spot." Your child will soon figure out that when it is sleep time, it is time to wear the brace. Your child is less likely to fuss if this is a consistent routine.
Pad the Bar
A bicycle handle bar pad works well for this. By padding the bar, you will protect your child, yourself and your furniture from the metal bar.
Never Use Lotion on the Skin
Lotion will make the problem worse. Some redness is normal with use. Bright red spots or blisters, especially on the back of the heel, usually indicate that the heel is slipping. Ensure that the heel stays down in the shoe by securing the straps and/or buckles. It is important to check your child's feet several times a day after starting bracing to make sure no blisters are developing.
If your child continues to escape from the brace, try the tips below. After each step, check to see if the heel is down. If not, proceed to the next step.
In boots or sandals with a single strap, tighten it by one more hole, using your thumb to hold the foot and tongue in place. In boots with multiple straps, tighten the middle one first, using your thumb to hold the foot and tongue in place.
Try double socks. In boots with a removable insert, place one sock directly over the foot, and a second sock over the insert to help take up excess room.
Remove the tongue of the shoe — this will not harm your child.
Try lacing the shoes from top to bottom, so that the bow is by the toes.
Use 40-inch round shoelaces.
Try thinner or thicker cotton socks, or the ones with non-slip soles.
....making effort to "STAY WELL"